Asthma represents a serious health problem in the United States (U.S.) despite recent advances in treatment options. According to the national data collected from 2001-2003, the average prevalence of current asthma in the U.S. population was over 7%, and the rates of asthma attacks during the preceding 12 months in those with current asthma ranged from 53% to 56%. Thus, Healthy People 2010 recognized asthma as one of its target health problems and has established specific goals including reducing asthma deaths, hospitalization related to asthma, emergency department visits for asthma exacerbations, activity limitations and missed school days related to asthma episodes.
Although asthma affects people of all ages, children and adolescents are disproportionately affected by the disease compared to other age groups. In fact, asthma is the most common chronic disorder in childhood. The prevalence of asthma in U.S. children and adolescents has increased steadily over the past two decades although the trend has plateaued in recent years. In 2006, based on CDC data, an estimated 6.8 million children under the age of 18 were affected, of which 4.1 million suffered from an asthma attack or episode. National surveillance data of 2001-2003, the most recent period for which data are available, revealed that asthma in children and adolescents annually accounted for 4.7 million physician visits, nearly 700,000 emergency department visits, and over 200,000 hospitalizations. Estimated annual health care costs for treating asthma in children in the U.S. are approximately $14.7 billion, and indirect costs (e.g. lost productivity by adult caretakers) add another $5 billion, for a total of $19.7 billion. Pediatric asthma, the leading cause of school absenteeism, is responsible for 12.8 million missed school days in the U.S. annually, and 24% of children with asthma report asthma-related activity limitations. Asthma also affects children's perception of their general health. While the majority of children (98%) under age 17 in the U.S. reported that they were in good to excellent health, only 4% of children with asthma reported a comparable degree of health.
Contrary to the common belief that asthma severity and morbidity is less in adolescents than in children, asthma remains a serious problem for many adolescents into adulthood. According to a recent CDC report, over 15% of high school students reported current asthma, of whom 40% had experienced asthma attacks or episodes during the preceding 12 months. In fact, asthma attacks are as common for adolescents as for younger children. Near-fatal episodes are highest among those 12-15 years of age. Severe exacerbations requiring hospitalization, intubations and cardiopulmonary resuscitation are more common in adolescents than in younger children. Despite high asthma morbidity, adolescents are less likely to use health care services than younger children.
A desire to overcome the emotional burdens and to gain peer approval through conforming to peers can make adolescents with asthma more vulnerable to risk behaviors. Anxiety and depressive disorders are associated with increased risk for smoking in adolescents with asthma. Adolescents with asthma tend to have more positive attitudes toward smoking, show a stronger intention to become smokers, and to have a self-image more closely linked to smoking than their non-asthmatic peers. Despite known risks, adolescents with asthma are more likely to smoke or at least as likely as their healthy counterparts to smoke. In large population-based studies in the U.S., 56% of adolescents with asthma reported lifetime smoking (ever smoked) and 20% to 30% engaged in current smoking. A study noted that adolescents who failed to take their asthma medication, despite asthma symptoms, smoked nearly twice as much as those who adhered to asthma treatment. Given its substantial and devastating impact at the individual, family and socioeconomic levels, strategies to assist adolescents in efficient asthma monitoring and management are imperative.